When does one retire?

I am at work this spectacular Memorial day weekend taking care of patients, pups, and the home. It is so funny working here at this small comunity hospital where the politics are generally ingrained in our everyday working lives; not so in a large University hospital as I worked at in MN.

For those of you who do not know what the "heck I do" let me elaborate. I am a PA, a Physician Assistant, at a hospital. My title is a "Hospitalist PA". This refers to the new trend of family practice and internal medicine Physicians hiring out to a specialist group to take care of their patients solely in the hospital. The benefits to the MDs are that Hospital medicine is mostly a money losing venue, so if they are able to fund their hospitalized patients with a grant to pay for that service, the family medicine and internist MDs dont lose money. The benefit to the hospital to pay the grant is that the Hospitalists obviously specialize, which translates into a larger volume, greater turnaround, and less money wasted on inappropriate admissions or testing. The benefit to the patient is that the length of stay goes down and the outcomes are better, be it through morbidity or mortality. Therefore, here I am. SO I work for an MD; typically there are two PAs on for every doc, and we work 8am-8pm. I admit patients from the ED up to the floors, I round on the patients that have already been admitted, and I also discharge patients to home, rehab, or nursing homes. I do not work in the ICU. Typically the MD does the highest acuity patients and then manages the PAs load by being a constant presence for advice and direction. He or she also cosigns all my notes and plans, and pops in to see all my patients. Therefore the benefit for a Hospitalist service to hire PAs is strictly monetary as well. I cost less than an MD and can do a large portion of the work.

Most of my patients are older, average age being 70s, range being 17 to 108 years old. My favorites are the old guys; as evidenced by my two favorite rotations in school being at the VA medical center. We get a lot of pneumonia, breathing problems from prior history of smoking, urinary tract infections that can spread to the blood, surgical problems like appendicitis and diverticulitis, broken hips and other broken bones from falls, fainting, heart attacks, other heart problems, strokes.....thats most of my day.

Do I ever think I will specialize? Yes, most likely. I love my job. I love the hospital; I doubt I will be outpatient at least in the near future. I love cancer but am more interested in talking to patients about it and seeing when they are sick and making them well than just pushing medications here and there, so who knows about oncology. I have thought about ER many many times; that may be a possibility too. Frankly, I am not bored with my job yet (surprise!) so am not too worried about moving on yet.

We are going through some contract renewals this year which means I may not get hired back and would have to change jobs at the end of the year. I am keeping my fingers crossed that that is not the case. Should we get resigned I will have job security for another three years. Should I need to start looking I know of a few options here and there, including a Hospitalist program in Concord, about 30 minutes north, which I could apply for. I know the MD that runs the program and have a few references so may be able to get in. All in good time.

So when is it that the average person retires? And do I qualify as "above average"?

Keeping busy near home

Some updated pics of me and Kerry; I am sure you all forgot what we look like and miss us dearly! These were taken at a wedding we recently attended; Kristen and Patrick, one of Ker's high school gang. The wedding was just down the street at St. Catherine's church (pretty sweet to walk down the road to the wedding!). I guess it was the 4th wedding of that group of Kerry's friends so it was good to spend some time with the girls and get to know them better. It takes so much time to spread real roots in an area; its part of the job that I have assigned to myself. I realize that especially when I am home in MN and so comfortable with everything. Ill get there with NH, just takes time and effort.

We have completed the wainscoting in the living room. John D, one of our close friends, did all the finishing carpentry work as Ker and I quickly realized we were in way over our heads.

We did all the painting, and it matches the crownmolding that we installed earlier this year perfectly. Its nice to paint when the weather is good so that the dogs can be outside during it. Three dogs, paint and plastic (ie the bubble wrap of the dogs world) do not mix.

I have to say, I think this room is finally finished. This is the 3rd out of 8 rooms. At this rate, our house will be finished in time for the next family to move in! At least it is all asthetic touches we are working on and not actual functional parts of the home.

There are also pics of our new landscaping. I need to work on boosting up the lawn next.

This is the view from the front; we got rid of the nasty looking bushes next to the breezeway and replaced them with a dogwood tree and a sand cherry bush. We also put in some holly bushes, a walking stick, a forsynthia, some boxwoods, an azalea, and moved some of our other plants. Kerry did all the lighting in the backyard. Don't ask me how; he was somehow able to pull the knowledge to make them year round and hooked to a switch in the garage. AMAZING! Its so pretty when its all lit up at night. He has a few lights turned to the rock wall to highlight that area. I extended our granite patio in the back as you can see with some new slate pieces and extra rock we had lying around, and I think instead of doing the full patio we are going to try and do more of this ourselves. Its pretty sturdy so far. We do need to figure out how to redo the grass in the back. Id like to grow it from seeds just to say I did it, but with the dogs running around and digging holes I have a feeling this is not plausible. This is a photo of the far left fencing of the backyard, and the bed we put in there too. Its fun to watch all the plants get bigger and NOT DIE. Grandma and I were talking about poinsettas last week; she has a spectacular green thumb as does my mom. I suck. Im trying not to suck quite as bad. Kers mom Linda is helping quite a bit, not only with giving us most of the plants from her very yard, but also helping me figure out how to take care of these strange NH plants.

The photo underneath here shows the backyard to the far right behind the garage. Last year it was filled to the brim with old leaves and other plant rubbage. I cleaned it out completely, mulched it, Kerry lit it and we planted our christmas trees we bought over the holidays. It extends the backyard immensely and gives the dogs another little private area to romp around and bark at the neighbors dogs.

The last picture shows my flower garden in the front. I planted all the daffodils that Linda brought us, and then put in pansies. I am just learning the difference between perennials and annuals, and killed my first set of annuals...these pansies will have to do until they are done blooming. There is no room for a vegetable garden anywhere, but there is this new fad of growing tomatoes in upside down planters that I plan on checking out.

So there you have it. Our happy abode with all the latest updates. Come, visit, see it for yourself!

Keeping up with the Kardashians

Or rather, keeping up with me. I think this is a spectacular venue to keep everyone apprised of the new house changes we are constantly doing, keep up with the growth of all my children (dogs) and so you can be the FIRST TO KNOW should I ever get engaged :)

I unfortunatly do not have any pictures from my recent visit home, but I will say it was a fantastic trip! We had a family lunch in the backyard with my dad grilling, my cousin Josh and cousin-in-law Meghans kids Joshua and Konur were there, my Aunt and Uncle Cheri and Ken showed up despite having plans for later, and of course my family was present. Derek even came later in the afternoon. My mom, sister and I got some shopping done for our ever-nearing trip to Costa Rica. Ill have to brush up on my espanol!

I also got some time with Candace, just "doing what we do" and kissed her baby Maple the beagle. Krista, Jesse and I hung out at their new house in St. Paul, a BEAUTIFUL cottage type home that they are spending a lot of time in fixing up just as we are. That must be part of being in ones late twenties. Krista and Jesse are getting married in December. Kerry and I get to go to the wedding!

Pics later, PEACE